ACC: Performance, rather than volume, should drive providers

ATLANTA—U.S. healthcare provider focus must be changed to hospital performance and outcomes rather than volume and throughput, said Janet Wright, MD, during a presentation at the 59th annual American College of Cardiology (ACC) scientific sessions on Monday.

As the definition stands, value equals quality over costs, according to Wright, however, “in the context of today’s environment where we don’t have the luxury to improve quality, we must improve value,” said Wright, ACC's senior vice president for science and quality.

She acknowledged that there is “tension between quality and costs,” but said this can be improved by the use of quality measurements.

Wright referred to the significant improvement of door-to-balloon times (D2B) after ACC evidence-based guidelines passed in 2006 focused on getting these times to 90 minutes or less. She said this initiative brought “incredible value” and has significantly helped to reduce patient mortality rates, exhibit cost-effectiveness and deliver patient-based care.

Initiatives like D2B, which reflect improvement and overall value to the system, are what ACC is striving to implement, she said. “We want to be able to demonstrate value and ideally improvement in the cost inflation of the efficiency of care to patients and the healthcare system overall,” said Wright.

Wright explained that the future of this improvement stems from alleviating the “twisted arrangement” that currently exists between payers and hospitals, referring to the reimbursement process. In regards to readmission rates, which she called “lapses and failure in the system of care” that are “extraordinarily expensive,” the future of reimbursement should rely in rewarding hospitals and staff who implement performance based outcomes rather than focus on volume and throughput.

Currently, she said that hospitals lose money by admitting physicians and are paid to readmit patients. “Reimbursement is reversed and doesn’t actually support the improvement of care,” she noted.

She said the ACC is focused on establishing an achievement or reward based system to recognize caregivers and patients who improve care. A reinvented system would “make sure that the value equation is in favor of the hospital.”

While Wright said hampering down on patient readmission rates could add to this process, strategies to improve appropriate imaging by using the Formation of Optimal Cardiovascular Imaging Strategies (FOCUS) would create a community of practitioners who strive to improve the “appropriate use of imaging.” This program, she explained, would “review the evidence and practices [of imaging] and improve those so they can implement the findings.”

“We are no longer satisfied with generated documents or guidelines” for performance measures, said Wright. Performance measures and appropriate use criteria must move into the implementation phase to improve the system rather than merely “sitting on the shelf” or “serving as a floor stop,” she explained.

Wright also said the “shared care project,” which originated in California, can help to use shared decision making to implement revascularization criteria.

The ACC's PINNACLE program, a network of healthcare professionals committed to induce performance improvement and rewards for appropriate care, can also help to revitalize quality and outcomes, said Wright.

PINNACLE would help to create achievement systems that would not only reward for outcomes, but measure them more clearly, she said. PINNACLE would produce a “road map for quality improvement" and “create a performance-based healthcare system."

Wright said that PINNACLE will eventually allow for real-time improvement data to be measured and placed into methods that can obtain and gauge the improvements in care.

“We believe that at some point the healthcare system will convert to a performance-based instead of this quality one,” she concluded.